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HEALTH-CARE WORKERS ARE OBLIGED TO IMMEDIATELY REPORT SUSPICIONS OF SEXUAL ABUSE

Facing the truth about child sex abuse

CHILDHOOD should be a happy and carefree time for games and for children to safely discover the world around them. But there are children who can no longer play innocent games with classmates and who have been forced to discover the pains and joys of adult life much earlier than they are supposed to. These are the children who suffer from sexual abuse – most of them behind the closed doors of their own supposedly safe homes.

CHILDHOOD should be a happy and carefree time for games and for children to safely discover the world around them. But there are children who can no longer play innocent games with classmates and who have been forced to discover the pains and joys of adult life much earlier than they are supposed to. These are the children who suffer from sexual abuse – most of them behind the closed doors of their own supposedly safe homes.

Hundreds of children fall victim to sexual abuse in Slovakia every year. In 2008, there were 391 cases, most of which (as many as 338 cases) were children between 6 and 14 years of age, according to police statistics provided to The Slovak Spectator by Andrea Polačiková, the spokesperson of the Police Presidium. But these are only the reported cases. According to Hana Bartová, a psychologist from The Hope Centre civic association, it is difficult to accurately estimate the actual number of sexually abused children.

“Estimates vary, but probably 5 – 15 percent of children experience some form of sexual violence, not including cases when a child meets an exhibitionist, as such a shock can be quite easily overcome and it doesn’t leave any traces on a child’s psyche,” Bartová told The Slovak Spectator.

To help victims of sexual abuse, the Health Ministry has prepared a new professional directive that will oblige health-care workers to more precisely report any suspicions of sexual abuse of children. Zuzana Čižmáriková, the spokeswoman of the Ministry of Health, said that physicians already have a duty to notify, and even though they have observed this, the notifications were done as a summary over a certain time period and not reported individually - and thus were not precise.

“Also the criteria for notification weren’t unified and suspicions about sexual abuse therefore weren’t reported,” Čižmáriková told The Slovak Spectator. The professional directive will thus define a method to discover and diagnose sexual abuse. According to Čižmáriková, the directive will define specific and non-specific symptoms. Until now, only cases with specific symptoms, such as pregnancy, had been reported. The new directive requires physicians also to report cases with less-specific symptoms, such as wounds, pain or bleeding in the genital areas.

Law obliges doctors to report

According to Peter Kováč, a lawyer and forensic pathologist from the Institute of Forensic Medicine Expertise, forensic.sk, in Bratislava, the duty to report cases of child abuse, including sexual abuse, is currently covered by the Act on Health-care Providers.

“The statement of the Ministry of Health about summary notifications is totally misleading, it’s even in conflict with one of the basic health-care laws – which I find shocking,” Kováč told The Slovak Spectator, explaining that every physician has a duty of notification to the prosecutor, an investigator or the police, who must be notified about “even any suspicion, without delay, and not as a summary but individually”.

This notification duty is clearly stated not only in the law but also in the code of ethics which health-care providers are to respect under the law, Kováč said.

“If someone claims anything else, they do not understand the matter,” Kováč told The Slovak Spectator. “Basically there is no need for any further professional directives since the law clearly defines the scope of the notification duty and the addressee of the notification. The professional directive might only touch the notification duty towards the ministry, but this change requires an amendment to the law since it touches upon breaking the silence of health-care workers.”

According to Bartová, professionals are often afraid to report suspicion of child abuse, as very often psychologists, social workers, judges or the police have doubts about what a child has said.
“They don’t want to believe that ‘such a nice person’ could abuse a child,” Bartová said. “Or they suggest that a four-year-old child has made it all up, which is absurd.”

Relatives of a child are often discouraged by professionals from reporting a case, but even more often the parents themselves do not want to see or admit that a family member could abuse a child.
According to Kováč, breaching the notification duty defined by the law can be sanctioned with fines of up to €3,319.

How many are paedophiles?

The most common, and at the same time most serious, problem that physicians face when suspecting and then trying to prove that a child has been molested (sexually or in another way) is the lack of information, reads an article written for paediatricians by Kováč and his colleagues Norbert Moravanský from forensic.sk and Daniel J. Spitz from Wayne State University’s School of Medicine in the US.

First, they write that the child is usually examined by different physicians each time he or she is taken to an emergency room. Also, the aggressor usually tries to often change the child’s paediatrician in order to not create a suspicion by one doctor. The anamnesis data can also be a problem too, since a physician often gets mediated information only from adults, often from the aggressor, and not from the child.

According to this article, only 10 percent of aggressors suffer from mental disorders. The authors write that 67 percent of the cases of sexual abuse of children were associated with alcohol and drug abuse by the aggressor.

According to Bartová, less than 3 percent of aggressors can be classified as paedophiles. She said that in most cases the main motive for sexual abuse is not sexual satisfaction but asserting one’s power over a weak and fearful child.

The most common cases of sexual abuse of children happen inside the extended family, the aggressor is often a close relative of the child – a father, stepfather, grandfather, uncle, or older brother.
“A frequently mentioned myth is that only a strange-looking person can abuse a child,” Bartová told The Slovak Spectator. “But the aggressor can be anyone, and often educated and intelligent ones abuse their children in a more wily way and it’s harder to find out about their acts due to their wily strategies.” Parents sometimes abuse their own children under the guise of a game.

According to Bartová, people tend to believe that child abuse only happens in families at lower social levels, by parents without education.

“Tyranny and abuse of children crosses the whole society, regardless of age, intellect, education, social status, religion, racial or ethnic group,” Bartová said.

If the court proves a crime was committed, the aggressor can spend three to 10 years in prison. In the event a child’s health was severely damaged, the punishment can be up to 15 years, and if the crime has fatal consequences, up to 20 years, Polačiková said.

However, according to Bartová many of these crimes go unpunished. Very often the police act too slowly. Once the case gets to court, the problem is that the child is often the only witness and, according to Bartová, it is easy for a good lawyer to contest the child’s statements. The myth that only a paedophile can abuse a child also complicates the legal process as many people, including professionals such as judges or psychologists, follow the thought pattern that if the accused is not clearly a paedophile, then he or she did not commit the crime.

To prevent this, stricter rules of reporting are not enough and there should be a system that would really help a child after sexual abuse is reported, Bartová said.

“Such a system doesn’t exist here. Everything depends on the approach, the knowledge about this problem and the personal engagement of professionals who should help the child and resolve the trauma,” Bartová said. “Our experience shows that Slovakia’s non-existent system causes secondary victimisation to children and only increases the trauma they experienced.”

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